Diabetic Foot: Surgical and bacteriological study

ABSTRACT

This work included 42 patients [30 males - 12 females] who came to surgical outpatient clinic in El-Minia and El-Mansoura University Hospitals from March 1991 to Jan. 1993. All patients were complaining of diabetic foot infection. Every patient was recommended for full history, clinical examination and laboratory study including a swab for bacteriological study and antibiotic sensitivity test. Preoperative stabilization of assessment for every patient by controlling of diabetes by insulin administration according to the blood and urine sugar test every 6 hours. We classified our patients into four groups group [A] included 18 patients [42.8 percent] presented with mild diabetic foot infection for whom we did surgical drainage with good results in 12 patients out of 18 patients [66.6 percent], group [B] were 13 patients [30.9 percent] with suppurative foot infection and tissue destruction, we performed surgical debridement and repeated dressing with halting of infection and healing in 11 patients out of 13 [84.6 percent], group [C] with pripheral vascular affection, we did surgical debridement associated with lumber sympathectomy which gave the best response in our work with good healing in 6 patients out of 7 patients [85.7 percent],group[D] their number were 4 patients [9.7 percent] presented with diabetic gangrene of the foot we performed amputation according to the popliteal pulsation and doplar examination with healing in all patients. The bacteriological results proved poly-microbial infection which necessiatated administration of multi- antimicrobial chemotherapies which supported the different surgical maneuvers. Diabetic foot is one of the difficult cases in its treatment but from our study we found that the early presentation of the diabetic foot infection with good preoperative assessment by controlling the diabetes mellitus and starting the proper antibiotic early with performing multi- surgical maneuvers according to the local presentation and the pripheral vasculature and repeated dressing carried the best outcome with good healing in a short period of time